Clinical analysis of suspected acute aortic dissection with ST-segment elevation detected by inferior leads

Abstract

Objective To analyze the clinical characteristics of suspected acute aortic dissection with ST-segment elevation detected by inferior leads in order to avoid the misdiagnosis of acute aortic dissection facilitating an appropriate treatment strategy carried out in time. Methods A total of 14 patients with suspected acute aortic dissection with ST-segment elevation detected by inferior leads were enrolled. Their clinical presentation, ECG features, imaging findings, laboratory testing, coronary angiography results, treatment and outcome were retrospectively analyzed. Results Clinical characteristics of suspected acute aortic dissection with ST-segment elevation detected by inferior leads suggested that hypertension as a single risk factor accounted for 79%.The patients with normal blood pressure or high blood pressure in emergency visits accounted for 86%. The amplitude of ST elevation in lead Ⅲ was greater than that in lead Ⅱ, and lead Ⅲ accompanied with ST elevation in lead V1 or V4R accounted for 86%. Significantly elevated D-dimer >2 000 ng/mL was found in those patients. Coronary angiography showed that the opening of coronary artery not seen, normal coronary arteries or a simple right coronary artery proximal lesion. Transesophageal echocardiography and computed tomography angiography were used to identify the diagnosis with 100% accuracy. The mortality rate of this group was 50%. Conclusions Patients with acute aortic dissection evidenced by ST-segment elevation detected by inferior leads are in critical setting of high mortality. Emergency surgical treatment can significantly improve the survival rate of patients. Key words: ST-segment elevation in inferior leads; Acute aortic dissection; Clinical characteristics